Our psychologists are fee-for-service and considered “out-of-network” with insurance carriers.

It means a provider is not contracted with an insurance plan. In these cases, to seek reimbursement for your visits, you can submit a superbill (see “Using a Superbill” below) to your insurance company for partial reimbursement. Payment is expected at the time of service, and any reimbursement from the insurance will be paid directly back to you.

The amount of reimbursement varies based on the insurance company and your specific plan. If you do not have your insurance booklet, we recommend calling your insurance company to ask the following questions:
• What is my yearly deductible for outpatient behavioral (mental) health?
• What is my yearly maximum for outpatient behavioral (mental) health visits?
• What is my deductible and co-payment for an out-of-plan provider?
• How much will you reimburse for billing code ______________?

Types of Services (CPT codes):
• 90791 Initial Psychiatric Evaluation (90 minutes)
• 90837 Individual Psychotherapy (60 minutes)
• 90846 Family Psychotherapy without patient present
• 90847 Family Psychotherapy with patient present
• 90853 Group Psychotherapy

• All insurers REQUIRE a formal diagnosis on any claim they process. This means that that in order for a claim to be considered for reimbursement, a diagnosis of a “mental health disorder” must be given. Certain diagnoses are typically not reimbursable which can further complicate billing.

• Managed health care plans (HMO’s and PPO’s) may require pre-authorization for mental health services in order for a consumer to be eligible for reimbursement. These plans often have a limited number of sessions available each year.

• Insurance carriers routinely request information about diagnoses, treatment plan/progress, clinical summaries, and at times copies of the clinical record, significantly limiting confidentiality. This information becomes part of the insurance company files and is typically stored in a larger database and/or even shared with a national health information data bank. While information is reportedly kept confidential, it is important to understand that it is no longer within the control of our team once it has been submitted to the insurance company.

• In our current health care system, diagnosed conditions (even psychological) become “pre-existing conditions” and can impact future applications for medical, life, or disability insurance. Insurance companies routinely check with medical information data banks when evaluating an applicant. Previous diagnoses of mental health conditions may impact determining acceptance and rate.

• Choosing to stay “in-network” can be limiting in that as a consumer there is some loss of control over options of providers and treatment decisions. Rather than decisions around clinical care being led by the psychologist and the individual or child and family, these decisions are determined by what is allowed by the insurance plan.

• Some providers who are in-network get used to being able to see patients on a weekly basis for extended periods of time. As a fee-for-service practice, we fully value the commitment our families make to get to appointments and work hard to build the skills necessary to lead to improvement.

We hope this information is helpful. Please let us know if you have additional questions that we can answer in regards to insurance submission. It is our desire to provide exceptional care and service, including when it comes to assisting with insurance. What we cannot guarantee, is that insurance companies will also do the same!

Using a Superbill to Submit To Insurance for Reimbursement
To process a reimbursement claim, insurance companies require certain materials and information. The following guide will help you navigate submitting your claim to your insurance company.

What Is a Superbill?
A superbill is a form used by medical practitioners who do not work directly with insurance companies to allow for reimbursement by insurance companies or an employer.

A ‘superbill’ will be prepared for each appointment once payment has been received and a request has been made.

The ‘superbill’ will contain the following elements:
• Your name
• Your date of birth
• Provider’s name
• Provider’s license number, NPI number, tax ID number
• Provider’s/Practice address
• Your diagnosis code
• The treatment(s) rendered to you
• The cost of the treatment
• The amount you paid
• Provider’s signature

For reference sake, a superbill is considered a financial document. Superbills (i.e. itemized statements) are not a part of the medical record but do contain medical information.

Submitting to Insurance
In order to maximize your reimbursement and expedite your insurance claim, we suggest that you include the following items in your claim submission to your insurance company:
• A superbill of services rendered at LindenBP.
• A patient claim form from your insurance company.
• A copy of your insurance card that includes your subscriber or member identification number.

Requesting a Superbill
When you are ready to submit to your insurance company for reimbursement:
• Ask the Front Desk staff for a “Superbill.”
• The superbill request form will be completed and the superbill will be processed within 48 hours.
• Indicate whether you would prefer your superbill to be mailed, emailed, or ready for you at your next visit.
***Please note that all charges must be paid before a superbill request can be processed.

Claim Form Information
• Claim forms can be found most easily on your insurance company’s general website under the “Claims” section.
• It is absolutely necessary that you fill out all requested information on this form.
• For your convenience, any information requested regarding your diagnosis and/or treatment codes is already included in your superbill.

When To Request Your Superbill/How Often to Get Reimbursement
This is a matter of personal preference. Here are some commonly utilized strategies patients use for applying for reimbursement:

• After every visit, request your superbill after scheduled appointment. Your superbill will include just the single date of service.
• At regular intervals throughout treatment (ex. monthly or quarterly).  Your superbill will include all dates of service since your last request.
• At the end of treatment. Request your superbill at your last scheduled visit. Your superbill will include every date of service throughout your course of care.

How do I submit to insurance
Prior to submitting the superbill (or claim form), we recommend that you call your insurance company and tell them you are going to send in a claim and that you want to verify that you have done it correctly.

• Review all the paperwork you have with them and ask if there is anything else you need. Some insurance companies require you to mail in original copy of their own insurance form. If so, be sure to fill that in, sign in, and attach the LindenBP superbill. We also encourage sending in a copy of your insurance card (front and back) with the claim.
• Confirm that mailing address that you should use to send in the superbill and ask your how long should you expect to wait for your claim to be paid (mark that date on your calendar).
• Once you have everything in order, send out the claim form to your insurance company. The address to send the claim form should be on the claim form itself.
• Keep a copy of the superbill for your records (and any other documentation that you submit). Make sure you receive a response for EACH claim mailed in (typically you will receive a response within 2-6 weeks).
• If you not have not received a response from the insurance company by the date marked on your calendar (or after 6 weeks), CALL them.to make sure they have received it and get an estimate for when you get a response. This is a very important step in processing your claim.
• Request your superbill based on specified time frame.